Compliance Officer

This is a fully remote position, open to applicants in New Jersey.

📋 Description

• Provide strategic leadership and oversight for the health plan compliance program, encompassing compliance governance, regulatory strategy, policy formulation, and cross-functional implementation.

• Ensure timely and accurate execution of regulatory deliverables across various business and operational sectors.

• Lead the design, implementation, and continuous effectiveness of the market compliance program in accordance with enterprise standards and regulatory expectations.

• Oversee adherence to CMS Medicare requirements, including obligations related to SNP, while ensuring timely submission of all pertinent regulatory filings and deliverables.

• Act as the senior compliance leader and the primary point of contact for state interactions, compliance meetings, and market-level escalations.

• Collaborate with Corporate Enterprise Risk Management and market leaders to identify, assess, document, and mitigate compliance and business risks.

• Conduct internal compliance auditing and monitoring activities, direct corrective action planning, and hold business owners accountable for prompt remediation and sustained compliance.

• Provide oversight of delegated entities, vendors, and key subcontractors, including annual performance monitoring and follow-up on corrective actions.

• Chair or support market compliance committees and regularly report to market and enterprise leadership regarding risks, trends, and remediation efforts.

• Lead, mentor, and develop compliance team members, establishing clear priorities, responsibilities, and performance expectations.

• For the New Jersey plan exclusively, additional responsibilities include maintaining and tracking contract documentation, Medicaid contract amendments, and various regulatory measures.

• Collaborate with Operational Departments to ensure that policies, procedures, and processes are created and updated to meet state regulatory standards.

• Offer guidance to various departments concerning regulatory and contract language.

• Develop strategic relationships with agencies within the New Jersey Department of Human Services and other state regulatory policymakers overseeing Managed Care organizations, as well as Medicare and Medicaid initiatives.

• Identify, evaluate, and analyze the effects of state regulatory changes, advising management on their implications.

• Represent senior management at various state committees, meetings, industry forums, and other engagements relevant to compliance and regulatory strategy.

• Maintain extensive knowledge of New Jersey Medicaid and applicable state regulatory requirements.

⛳️ Requirements

• Bachelor's Degree in a related field or equivalent experience is required.

• A Master's Degree in a related field is preferred.

• A minimum of 7 years of experience in Compliance program management and contract experience with State Medicaid programs, including internal and State audits, is required.

• At least 5 years of experience with health care regulatory agencies in the development of compliance and fraud programs is required.

• A minimum of 5 years of experience overseeing the implementation of contract requirements is required.

• Over 10 years of experience in Compliance/Enterprise Risk Management is preferred.

🏝️ Benefits

• Competitive pay

• Health insurance

• 401K and stock purchase plans

• Tuition reimbursement

• Paid time off plus holidays

• Flexible work arrangements including remote, hybrid, field, or office schedules